Mindfulness physical therapy, pain management, rehabilitation

Mindfulness and Experimental Pain

In a study by Zeidan and colleagues, functional magnetic resonance imaging (fMRI) was used to investigate the neural mechanisms modulating pain perception in 15 healthy volunteers who received brief training in mindfulness meditation.1 Following 20 – minute mindful breath awareness instruction on 4 training days, subjects meditating in the presence of noxious heat stimuli experienced a significant reduction in pain intensity of 40% and pain unpleasantness of 57% compared to rest conditions.

On fMRI, mindfulness meditation reduced nociceptive – related activity in the contralateral primary somatosensory cortex. Reductions in pain intensity were associated with increased activity in the anterior cingulate cortex and anterior insula, brain areas involved in the cognitive modulation of nociceptive processing. Reductions in pain unpleasantness were associated with increased activity in orbitofrontal cortex, an area associated with reframing sensory events. Decreases in pain unpleasantness were also associated with decreased activity in the thalamus.

Study authors conclude that, in healthy individuals, brief mindfulness meditation training can contribute to reductions in pain perception and these reductions may, in part, be the result of the top – down inhibition of ascending nociceptive information by neural mechanisms associated with enhanced cognitive control and the reframing of nociceptive information. As subjects in this study were healthy volunteers, the application of these results to chronic pain populations is limited. The neural mechanisms by which mindfulness meditation training may modulate pain perception in chronic pain populations remains to be determined and is an important area for future research.

For a detailed discussion of the neural mechanisms of mindfulness-based pain relief, see: Zeidan F, Vago DR. Mindfulness meditation – based pain relief: a mechanistic account. Ann N Y Acad Sci. 2016 Jun;1373(1):114-27.

1 Zeidan F, Martucci KT, Kraft RA, et al. Brain mechanisms supporting modulation of pain by mindfulness meditation. J Neurosci. 2011 April 6;31(14):5540 – 8.